scholarly journals Chronic obstructive pulmonary disease and HIV-infection

2021 ◽  
Vol 12 (4) ◽  
pp. 23-31
Author(s):  
I. B. Viktorova ◽  
V. N. Zimina ◽  
A. V. Kravchenko
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hiv Infection ◽  
Pulmonary Disease ◽  
Mutual Influence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Economic Significance ◽  
Lung Condition ◽  
Infectious Disease Specialists ◽  
Clinically Significant

The increasing life expectancy of HIV-infected persons due to antiretroviral therapy (ART) is associated with growing frequency of non-opportunistic respiratory diseases. This review of literature is devoted to chronic obstructive pulmonary disease (COPD), which is known to be the most common chronic noninfectious lung condition in HIV-patients. The prevalence of COPD in the global population with HIV is high and is associated with HIV.The article contains actual data on HIV/COPD comorbidity, presents current information on mechanism of COPD development in HIV-infection, factors contributing to the mutual influence and adverse course of comorbid conditions. The specialties of COPD treatment during ART and clinically significant drug interactions between different COPD medications and some antiretrovirals are highlighted.The socio-economic significance of both HIV-infection and COPD argues wide informing of pulmonologists, therapists and infectious disease specialists about the course and treatment of COPD in persons with HIV-infection.

scholarly journals Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Gamal Agmy ◽  
Manal A. Mahmoud ◽  
Azza Bahaa El-Din Ali ◽  
Mohamed Adam
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Cutoff Point ◽  
Whole Body ◽  
Significant Response ◽  
Chronic Obstructive ◽  
Lung Volumes ◽  
Obstructive Pulmonary Disease ◽  
Gold Stage ◽  
Clinically Significant

Abstract Background Reversibility measured by spirometry in chronic obstructive pulmonary disease (COPD) is defined as an increase in forced expiratory volume in first second (FEV1) that is both more than 12% and 200 mL above the pre-bronchodilator value in response to inhaled bronchodilators. FEV1 only may not fully reverberate the changes caused by reduction in air trapping or hyperinflation. To date, the studies that examined the effect of inhaled bronchodilators (BD) on residual volume (RV) and total lung capacity (TLC) are limited. This study was carried out to assess the differences between flow and volume responses after bronchodilator reversibility testing in patients with different COPD GOLD stages (GOLD stage I to stage IV). Spirometry and whole body plethysmography were done before and 15 min after inhalation of 400 μg salbutamol. Results Majority (53.3%) of cases were volume responders, 18.7% were flow responders, 20% were flow and volume responders, and 8% were non responders. Significant increase in Δ FEV1% was found in 15% of cases while 55% showed a significant increase in Δ FVC (P= < 0.001). Mean difference of Δ FVC (L) post BD was significantly increased with advancing GOLD stage (P= 0.03). A cutoff point > 20% for Δ RV% had 70% sensitivity and 60% specificity and > 12% for Δ TLC% showed 90% sensitivity and 45% specificity for prediction of clinically significant response to BD based on FEV1. A cutoff point > 18% for Δ RV% had 78% sensitivity and 29% specificity and > 14% for Δ TLC% had 50% sensitivity and 70% specificity for prediction of clinically significant response to BD based on FVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilators with advancing GOLD stage. Measurement of lung volumes in addition to the standard spirometric indices is recommended when determining bronchodilator response in COPD patients.

scholarly journals System of control in the organization of pulmonary rehabilitation of persons with chronic obstructive pulmonary disease

2019 ◽  
Vol 5 (3) ◽  
pp. 69 ◽  
Author(s):  
K.A. Tymruk-Skoropad ◽  
Iu.O. Pavlova ◽  
M.A. Mazepa
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Control System ◽  
Physical Therapy ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Current Control ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Clinically Significant

<p><strong>The aim</strong><strong>: </strong>to substantiate the structural components of the control system aimed at improving the physical therapist’s work during pulmonary rehabilitation (PR) of COPD persons.</p><p><strong>Materials and methods. </strong>Analysis and generalization of the data of the special scientific and methodological literature on the issues of physical therapy of patients with chronic obstructive pulmonary disease; method of analysis of medical records; elaboration of Internet sources, including databases of evidence based medical literature.<strong></strong></p><p><strong>Results. </strong>The control system, which is reasonable to be implemented at three stages (preliminary, current, final) of the process of physical therapy (PT) and PR of patients with COPD, is substantiated.</p><p>The control system within the competence of the physical therapist provides for rehabilitation examination (preliminary control), monitoring (current control) and final evaluation of certain indicators. There were 5 groups of main indicators: quality of life/ activity and participation, disease course, body functions, body structures, educational competence. For the selected groups of indicators, the selection of measuring instruments was made, the features of their application at different stages were outlined, the values of the minimum clinically significant difference for the selected indicators were given.</p><p><strong>Conclusions. </strong>The process of pulmonary rehabilitation of people with COPD needs to be evaluated and monitored for its effectiveness in accordance with the expected results.</p><p>The monitoring system allows to track all changes in the patient's health and functioning, regulate the intervention and its intensity, evaluate both the individual physical therapy session and the effectiveness of the entire program.</p><p>One of the criteria of the control system is the effectiveness of PT and PR, which is evaluated on the basis of the dynamics and direction of changes of the studied indicators, their compliance with the expected result and taking into account the values of the minimal clinically significant difference for the evaluated indicators.</p>

scholarly journals Possibilities to prevent acute exacerbation of chronic obstructive pulmonary disease using inhalational therapy. A Report of Expert Panel of Russian Respiratory Society

2018 ◽  
Vol 28 (3) ◽  
pp. 368-380 ◽  
Author(s):  
S. N. Avdeev ◽  
A. S. Belevskiy ◽  
Z. R. Aisanov ◽  
V. V. Arkhipov ◽  
I. V. Leshchenko ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Clinically Significant ◽  
Long Acting ◽  
Exacerbation Of Copd ◽  
Inhalational Therapy

An impact of acute exacerbation of COPD (AECOPD) on the course and the prognosis of chronic obstructive pulmonary disease depends on severity of the exacerbation. Moderate and severe exacerbations are considered as clinically significant events. Clinical studies investigating a role of inhalational therapy for the risk of AECOPD differed significantly in important parameters and the patients involved were not fully described in the real clinical practice. Tiotropium alone did not demonstrate any benefit over other inhalational therapies, such as inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combinations and long-acting muscarinic antagonist (LAMA)/LABA combinations, for risk reduction of moderate to severe exacerbations. A benefit of tiotropium/olodaterol combination over tiotropium for the reduction of risk of clinically significant exacerbations was first shown in DYNAGITO study; patients’ groups in this study did not differ in a rate and a spectrum of adverse events including cardiovascular events. An efficient bronchodilating therapy should be administered to all patients with COPD as it could improve dyspnea and prevent exacerbations. Further escalation of treatment in patients with frequent exacerbations of COPD should be personalized according to clinical course and causes of AECOPD. 

scholarly journals Drug Metabolism in Severe Chronic Obstructive Pulmonary Disease: A Phenotyping ‘Cocktail’ Study

2020 ◽  
Author(s):  
Richard McNeill ◽  
Mei Zhang ◽  
Michael Epton ◽  
Matthew Doogue
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Drug Metabolism ◽  
Pulmonary Disease ◽  
Fold Increase ◽  
Drug Clearance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Clinically Significant ◽  
Healthy Participants ◽  
Severe Copd

Aims To evaluate the effect of severe chronic obstructive pulmonary disease (COPD) on drug metabolism by comparing the pharmacokinetics of patients with severe COPD with healthy volunteers and using the modified ‘Inje’ drug cocktail. Methods This was a single-centre pharmacokinetic study with 12 healthy participants and 7 participants with GOLD D COPD. Midazolam 1 mg, dextromethorphan 30 mg, losartan 25 mg, omeprazole 20 mg, caffeine 130 mg, and paracetamol 1000 mg were simultaneously administered and intensive pharmacokinetic sampling was conducted over 8 hours. Drug metabolism by CYP3A4, CYP2D6, CYP2C9, CYP2C19, CYP1A2, UGT1A6 and UGT1A9 in participants with COPD were compared with phenotypes in healthy controls. Results The oral clearance (95% CI) in participants with COPD relative to controls was: midazolam 63% (60-67%), dextromethorphan 72% (40-103%), losartan 53% (52-55%), omeprazole 35% (31-39%), caffeine 52% (50-53%), and paracetamol 73% (72-74%). There was a five-fold increase in AUC for omeprazole and approximately two-fold increases for caffeine, losartan, dextromethorphan, and midazolam. The AUC of paracetamol, which is mostly glucuronidated, was increased by about 60%. Conclusion Severe COPD is associated with a clinically significant reduction in drug clearance. This may be greater for cytochrome P450 substrates than for glucuronidated drugs. This supports reduced starting doses when prescribing for patients with severe COPD.

scholarly journals Relationship of Pneumocystis jiroveci Humoral Immunity to Prevention of Colonization and Chronic Obstructive Pulmonary Disease in a Primate Model of HIV Infection

2010 ◽  
Vol 78 (10) ◽  
pp. 4320-4330 ◽  
Author(s):  
Heather M. Kling ◽  
Timothy W. Shipley ◽  
Sangita P. Patil ◽  
Jan Kristoff ◽  
Marianne Bryan ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hiv Infection ◽  
Pulmonary Disease ◽  
Normal Lung ◽  
Chronic Obstructive ◽  
Primate Model ◽  
Pneumocystis Jiroveci ◽  
Obstructive Pulmonary Disease ◽  
Specific Memory ◽  
Shiv Infection

ABSTRACT Pulmonary colonization by the opportunistic pathogen Pneumocystis jiroveci is common in HIV+ subjects and has been associated with development of chronic obstructive pulmonary disease (COPD). Host and environmental factors associated with colonization susceptibility are undefined. Using a simian-human immunodeficiency virus (SHIV) model of HIV infection, the immunologic parameters associated with natural Pneumocystis jiroveci transmission were evaluated. SHIV-infected macaques were exposed to P. jiroveci by cohousing with immunosuppressed, P. jiroveci-colonized macaques in two independent experiments. Serial plasma and bronchoalveolar lavage (BAL) fluid samples were examined for changes in antibody titers to recombinant Pneumocystis-kexin protein (KEX1) and evidence of Pneumocystis colonization by nested PCR of BAL fluid. In experiment 1, 10 of 14 monkeys became Pneumocystis colonized (Pc+) by 8 weeks post-SHIV infection, while 4 animals remained Pneumocystis colonization negative (Pc−) throughout the study. In experiment 2, 11 of 17 animals became Pneumocystis colonized by 16 weeks post-SHIV infection, while 6 monkeys remained Pc−. Baseline plasma KEX1-IgG titers were significantly higher in monkeys that remained Pc−, compared to Pc+ monkeys, in experiments 1 (P = 0.013) and 2 (P = 0.022). Pc− monkeys had greater percentages of Pneumocystis-specific memory B cells after SHIV infection compared to Pc+ monkeys (P = 0.037). After SHIV infection, Pc+ monkeys developed progressive obstructive pulmonary disease, whereas Pc− monkeys maintained normal lung function throughout the study. These results demonstrate a correlation between the KEX1 humoral response and the prevention of Pneumocystis colonization and obstructive lung disease in the SHIV model. In addition, these results indicate that an effective Pneumocystis-specific memory B-cell response is maintained despite progressive loss of CD4+ T cells during SHIV infection.

Chronic obstructive pulmonary disease

2020 ◽  
pp. 4098-4141
Author(s):  
Nicholas S. Hopkinson
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Tobacco Smoke ◽  
Lung Parenchyma ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Variable Extent ◽  
Lung Condition ◽  
History Of

Chronic obstructive pulmonary disease (COPD) is a lung condition caused by the inhalation of noxious materials, principally tobacco smoke, and characterized by airflow limitation that is not fully reversible. Key features are cough, sputum production, and breathlessness. There are chronic progressive symptoms and acute exacerbations. The term COPD incorporates several pathological processes, present to a variable extent in any given individual, involving both the airways (chronic bronchitis) and the lung parenchyma (emphysema). Most COPD patients will have one or more other long-term conditions. COPD is the third leading cause of death worldwide. COPD should be considered in those over the age of 35 who have (1) exposure to risk factors, usually, but not exclusively, tobacco smoke; (2) a history of chronic progressive respiratory symptoms; (3) airflow limitation that is not fully reversible.

scholarly journals Хроническая обструктивная болезнь лёгких: фокус на обострение заболевания

2019 ◽  
pp. 97-100
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Review Article ◽  
Microbial Colonization ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Clinically Significant

he review article reveals the problems associated with exacerbation of chronic obstructive pulmonary disease (COPD). The main causes of COPD exacerbations are analyzed and the severity of exacerbations for patients is substantiated. Special attention is paid to microbial-mediated inflammation in the lungs. The authors point out that the problem of chronic microbial colonization is clinically significant, but not fully studied and demands further researches.

Results of a pilot investigation into a complex intervention for breathlessness in advanced chronic obstructive pulmonary disease (COPD): Brief report

2010 ◽  
Vol 8 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Morag Farquhar ◽  
Irene J. Higginson ◽  
Petrea Fagan ◽  
Sara Booth
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Controlled Trial ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Intervention Service ◽  
Clinically Significant ◽  
The Impact

AbstractObjective:Breathlessness is the most common devastating symptom of advanced chronic obstructive pulmonary disease (COPD). The Breathlessness Intervention Service (BIS) is a multidisciplinary service that uses both pharmacological and non-pharmacological evidence-based interventions to reduce the impact of the symptom. The results of a Phase II evaluation of the service are reported.Method:Pretest - posttest analysis of non-randomized data was performed for 13 patients with severe advanced COPD referred to BIS.Results:Mean VAS-Distress scores (primary outcome measure) decreased (improved) for the group between baseline and follow up suggesting a clinically significant improvement: 6.88 (SD = 2.50) to 5.25 (SD = 2.99). At an individual level, 11 of the 13 patients showed a decrease in their distress due to breathlessness, and for eight of these this was clinically significant (range of all decreases 0.3–7.1 cm). Changes in secondary outcome measures are also reported.Significance of results:The Breathlessness Intervention Service appears to reduce distress due to breathlessness among patients with advanced COPD. A Phase III fully-powered randomized controlled trial is warranted.

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